American Journal of Perinatology

OBJECTIVE: The aim of the study was to investigate the virulence factors in Escherichia coli producing extended-spectrum beta-lactamase (ESBL) derived from the perinatal fecal colonization flora of mothers and their newborns in a Chinese obstetric ward. STUDY DESIGN: Rectal swabs were obtained from mothers prenatally and from their newborns postnatally, and analyzed for ESBL-producing E. coli. The isolates were then whole-genome sequenced. RESULTS: Maternal and neonatal colonization by extended spectrum beta-lactamase (ESBL)-producing E...

OBJECTIVE:  Umbilical cord vascular rupture is a rare and severe condition that can occur during labor, leading to adverse outcomes for the fetus before as well as after delivery. Prompt diagnosis and intervention are crucial for improving the chances of a successful outcome. We aimed to analyze cases of umbilical cord vascular rupture during labor to provide insights into this challenging condition. STUDY DESIGN:  This retrospective study evaluated the medical records of patients diagnosed with umbilical cord vessel rupture or umbilical cord hematoma at Fujian Maternity and Child Health Hospital from January 1, 2015, to May 31, 2023...

Pregnancies affected by both pregestational and gestational diabetes mellitus carry an increased risk of adverse maternal and neonatal outcomes. While the risks associated with diabetes in pregnancy have been well documented and span across all trimesters, maternal and neonatal morbidity have been associated with select third-trimester complications. Further, modifiable risk factors have been identified that can help improve pregnancy outcomes. This review aims to examine the relationship between select third-trimester complications (large for gestational age, intrauterine fetal demise, hypertensive disorders of pregnancy, preterm birth, perineal lacerations, shoulder dystocia, and cesarean delivery) and the aforementioned modifiable risk factors, specifically glycemic control, blood pressure control, and gestational weight gain...

OBJECTIVE:  This study aimed to (1) evaluate whether endothelial dysfunction, as measured by peripheral arterial tonometry (PAT) indices and biomarker (soluble fms-like tyrosine kinase-1 [sFLT], brain natriuretic peptide [BNP]) levels at 34 weeks gestation, can predict progression from nonsevere to severe hypertensive disorders of pregnancy (HDPs); and (2) develop a clinical risk model for prediction of progression from nonsevere to severe HDP. STUDY DESIGN:  We prospectively enrolled patients with a singleton gestation carrying a nonsevere HDP diagnosis...

OBJECTIVE:  Both hepatitis C virus (HCV) and opioid use disorder (OUD) have been associated with higher rates of preterm birth (PTB). It is unknown whether the higher prevalence of HCV in individuals with OUD may contribute to this association. The objective of this study is to evaluate the association between HCV and PTB in pregnant individuals with OUD. STUDY DESIGN:  We conducted a retrospective cohort of pregnant individuals with OUD who participated in more than three visits in a co-located multidisciplinary program...

Previable premature prelabor rupture of membranes (pPPROM) can lead to significant maternal and neonatal morbidity and mortality. Limited literature exists describing long-term outcomes in neonates surviving pPPROM. Our study describes 2-year survival and outcomes after expectantly managed pPPROM at a single, tertiary, academic center. This is a retrospective review including individuals with pPPROM defined as membrane rupture before 240/7 weeks who were candidates and opted for expectant management at a single tertiary academic center between 2013 and 2022...

The incidence of gestational diabetes mellitus (GDM) continues to increase in the United States and globally. While the first-line treatment of GDM remains diet and exercise, 30% of patients with GDM will require pharmacotherapy. However, many controversies remain over the specific glycemic threshold values at which pharmacotherapy should be started, how intensified the therapy should be, and whether oral agents are effective in GDM and remain safe for long-term offspring health. This review will summarize recently completed and ongoing trials focused on GDM pharmacotherapy, including those examining different glycemic thresholds to initiate therapy and treatment intensity...

OBJECTIVES: Neonatal resuscitation is a high acuity, low-occurrence (HALO) event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP®) guidelines and teamwork. STUDY DESIGN: A TS study was conducted monthly in one rural hospital over a ten month period from November 2020 to August 2021...

OBJECTIVE: Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT. STUDY DESIGN: This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010-2021. The primary outcome was severe maternal morbidity (SMM)...

Ferritin, commonly used for diagnosing iron deficiency (ID) in pregnancy, is limited by high cost and false elevations during inflammation. Reticulocyte hemoglobin equivalent (Ret-He), an alternative marker for ID, is unaffected by inflammation and analyzed on the same collection tube as the standard complete blood count (CBC). We aimed to determine the accuracy of Ret-He in detecting ID in pregnancy compared to ferritin in a United States cohort. This prospective cohort study enrolled 200 pregnant participants, recruited in any trimester if a CBC was drawn as part of routine prenatal care...

We sought to assess the impact of a prolonged latent phase (PLP) on maternal and neonatal morbidity.   This is a secondary analysis of a prospective cohort study conducted 2010-2015 that included all term gravidas who reached active labor (six centimeters). Primary outcomes were composite maternal morbidity (maternal fever, postpartum hemorrhage, transfusion, endometritis, and severe perineal lacerations) and composite neonatal morbidity (respiratory distress syndrome, mechanical ventilation, birth injury, seizures, hypoxic ischemic encephalopathy, therapeutic hypothermia, or umbilical artery pH < 7...

OBJECTIVE: The majority of breech fetuses are delivered by Cesarean birth as few physicians are trained in vaginal breech birth. An external cephalic version (ECV) can prevent Cesarean delivery and the associated morbidity in these patients. Current guidelines recommend all patients with breech presentation be offered an ECV attempt. Not all attempts are successful, and an attempt does carry some risks so shared decision-making is necessary. To aid in patient counseling, over a dozen prediction models to predict ECV success have been proposed in the last few years...

Objective Chronic hypertension is a known risk factor for the development of preeclampsia and obstetrical morbidity. However, recent risk estimates, particularly in the era of use of low-dose acetylsalicylic acid for preeclampsia prevention, are lacking. This study aimed to estimate the association between chronic hypertension and preeclampsia and other adverse pregnancy outcomes in a contemporary cohort of births spanning the period since the introduction of a low-dose acetylsalicylic acid protocol. The secondary outcome was to estimate trends in preeclampsia and preterm birth among patients with chronic hypertension during the study period...

BACKGROUND: Between 2008-2016, 23% of pregnancy-related deaths in Ohio occurred in an emergency department (ED) or outpatient setting. Prior research showed 98% of Ohio's delivery hospitals conduct obstetric (OB) emergency simulations, while only 30% include ED staff. The goal of the grant was to increase knowledge, skill, and self-efficacy of emergency medicine (EM) professionals in managing OB emergencies. In addition to EM professionals, there was high interest by obstetrics and gynecology (OB/GYN) and other professionals in the course...

BACKGROUND: Non-Hispanic Black pregnancies are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the US. OBJECTIVE: Identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black pregnancies. STUDY DESIGN: Population-based retrospective case-control study of US birth records (2012-2016). Factors potentially associated with PTB and considered indicators of SDoH were compared between singleton live births of non-Hispanic Black individuals delivering preterm (<37 weeks) and term (≥37 weeks gestation)...

OBJECTIVE: Provide contemporary data on maternal and infant outcomes after delivery to better understand risks of Cesarean section (CS). STUDY DESIGN: Data for deliveries in 2019 and 2020 were obtained from a large US commercial healthcare claims database. Maternal morbidity measures included twenty Severe Maternal Morbidity (SMM) outcomes and seven additional obstetric and mental health outcomes. Infant morbidity measures included eight outcomes related to respiratory health, digestive health, atopic dermatitis, and birth trauma...

OBJECTIVE: Hypertensive disorders of pregnancy (HDP) can be diagnosed prior to labor, during labor, or postpartum. We evaluated whether the timing of HDP diagnosis impacts postpartum blood pressure (BP) outcomes. STUDY DESIGN: Secondary analysis of 384 patients with HDP from a trial evaluating furosemide use on BP outcomes. The timing of HDP diagnosis was categorized into: diagnosis in the antepartum period, prior to labor versus diagnosis peripartum (during labor or first day postpartum)...

The consensus in the literature supports the need for careful monitoring and management of maternal blood glucose during labor to optimize neonatal outcomes. Guidelines generally recommend strict control of maternal blood glucose during labor, involving frequent checks, and the use of dextrose and insulin as needed. However, recent evidence has not consistently shown a strong association between strict control of blood glucose and a reduction in the rate of neonatal hypoglycemia. This raises questions about the extent to which intrapartum blood glucose control impacts neonatal hypoglycemia...

OBJECTIVE:  This study aimed to evaluate the most effective regimen to raise hemoglobin (Hb) by comparing alternate-day dosing of iron to daily dosing in pregnant women with iron deficiency anemia. STUDY DESIGN:  Women with Hb < 11.0 g/dL and ferritin ≤ 25 µg/L between 120/7 and 340/7 weeks' gestation were recruited. A total of 88 patients were randomized using block randomization with 1:1 allocation to receive either 1 tablet of 325 mg ferrous sulfate on consecutive days or 2 tablets every other day...

Objective Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves pre-delivery hemoglobin (Hb). However, this condition is often overlooked and inadequately treated in postpartum care settings. We aimed to determine if implementation of a standardized protocol for postpartum anemia increases postpartum IVFe use and affects clinical outcomes. Study Design We performed a prospective cohort study evaluating implementation of a standardized inpatient protocol for postpartum anemia...